REV106231

• Permit No: M1985184
• IBM Index Class Name: Revision
• Doc Date: 9/8/1997
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS - APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

II
ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
-2-
r~ -gs - ~ gy

3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
S ~fl v
Pblo. Zip Code: goSZ
9"7~ Telephone: ~/~Z - ~s3 7
4. Successor Operator:
Contact Person: ~ICI~ /~~ ~`~'~
Company Name: /UAJ-~A
Street: X62 I,utLGou Lv`
City : - [col .,
State: O _ Zip Code: o $ Z
Area Code: °~70 Telephone: yg~- O.3s~
IRS Tax ID No. or Social Security No.: Q~/- ~ 2 c/Q
5. Application Fee: $100.00
Make check payable to the Division of Minerals and Geology .